How to Successfully Prepare, Submit and Negotiate the Claim

Previous articles in this series have discussed insurance claims for wildfires, but we have not yet explained how to make a living after a person dies. In this series of wildfires in this blog, we talk about the preparation, presentation and negotiation of insurance claims.

Preparing a claim

It is important to file a claim as soon as possible, as different policies provide different time limits. Insurers typically cite a variety of “late” filings as grounds for rejection.

Insurance providers have the right to receive reasonable documents before paying. In most cases, you do not want to consider a claim for benefits unless such documents are provided. The policy states that a hard copy must be submitted or recorded online, but in any case it is recommended that the copy be stored online or in a remote geographical location.

The level of detail required depends on the insurance provider. Provide as much information as possible at the time the claim is filed, including details of damaged or damaged items (photos and videos are helpful), estimates and other documents.

While some supplements are expected, the back and forth, which are often associated with repeated insurance claims, may, unfortunately, take time. When the insurer receives the information as soon as possible Really What is needed is that the owner of the policy will be able to resolve the claim as soon as possible and receive payment. In some cases, it may be easier for the insurer to make payments – when they have enough information and the policyholder collects more information for other areas.

While the insurance company must comply with the specified obligations, resolving a claim is negotiation. In general, honesty is very important to find a possible solution, so the policy maker should only ask in a reasonable way.

Proof of extinction

Policies may contain a “Bankruptcy Proof” that requires the policy buyer to provide a detailed information on the basis of the claim within a few days after the claim is filed. Some insurance companies argue that this is a prerequisite for any cover claim, and judgments vary on the merits of this dispute. In California, the policyholder has 60 days to prove his or her loss, and as long as there is a concern that this deadline may not be met (usually as a wildfire claim), it is normal for the insurer to extend the deadline. Given.

California has a record of so-called “advertising-prejudice,” but the Supreme Court can guarantee the defendant by violating the policy, saying, “Unless the insurer is the insurer, the violation cannot be a valid defense. Therefore, we have prejudice.^[1] This principle is expressed in the context of a wildfire site in Southern California, and the failure of policy makers to submit the required forms within the specified time period is considered to be in line with the insurer’s ability to investigate smoke and soot damage.^[2] The court rejected the insurer’s final judgment, because the insurer was not prejudiced in his cooperation and the insurer had the opportunity to conduct his own investigation.

Interacting with adapters after claim

Insurers make sure they want to be a partner in the process and that they need more time. Policymakers should give insurers the opportunity to do the right thing with the best of intentions, but not to confuse their friendship with the policyholder (although there is a requirement that insurers must put the policyholder’s interests ahead of their own).

Claim editors try to help, but even the best of them are dealing with thousands of claims from individuals and businesses in the event of a similar tragedy. It can also be confusing for them, so it is important to keep a careful note of each contact and / or keep a record of your phone calls instead of relying on phone calls by email or correspondence. To build and support the relationship with the Editor, the policyholder is approached with compassion and respect for the editors, understanding the number of claims they have. Respond to logical questions to get information as soon as possible.

Some actions cannot be expected. Businesses want to re-engage by hiring contractors and starting repairs or rebuilding. Insurance providers usually understand and pay according to the policy.

But in the case of non-urgent actions, it is appropriate to give insurers a reasonable chance in the process. This is more than a matter of respect, partnership or strategy. Many policymakers say they must seek the insurer’s permission to repair or replace anything insured. And if the policyholder does not attempt to protect the insurer’s prior authorization, the insurer will not be willing to pay the costs “voluntarily.”

Read the insurance provider’s cover layout

After the insurer submits the claim, the insurer acknowledges the acceptance of the claim. Shortly thereafter, the insurer will respond in the long run by identifying any additional information and / or coverage of the claim that may be needed to further evaluate the claim. Read this link carefully. What does the insurer agree to pay and what is rejected? Discussing other issues / will you pay an advance on the claims you have agreed to during the investigation? Will he open the door for an additional fee as soon as he receives more information?

The owner of the policy should try to provide as much information as possible. That said, some insurers may ask for more information than they legally need. It is good to try to reach out to discuss these questions and the burdens associated with respect. All communications and agreements must be confirmed in writing.

If the insurer refuses to cover the claim or does not pay what the policyholder believes, the policyholder may seek the advice of an insurance specialist. The lawyer can review the insurer’s position, advise on rights, and help you negotiate with the insurer.

In some cases, the claimant will make a claim. In some cases, this may result in the loss of the policyholder in full. Other times the insurer offers less because they missed something or need more detail; Where available, the requested information must be provided or an explanation as to why it is not available. And in other cases, the policyholder may offer less in the hope that he or she will take a statement on the value of the claim, or in the belief that the policy owner will accept the offer because he or she needs the money. Note that this may be part of the process for many insurers, even if it may seem inappropriate. No matter how difficult it may be, think of it as a business negotiation – which one for them. Acting out of anger can be counterproductive. Advocacy lawyers can be helpful in this process.

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This is the seventh in a series of wildfires in the blog.

* This post is excerpted from an article written by Scott Davies and Joseph Itkin. Journal on issues that arise in litigation Published by Fastcase Full Court Press, Volume 2, No. 3 (Summer 2022), pp. 213-222 (list of all references is provided in the published issue of this magazine).

[1] Campbell v. Allstate Ins. Co. 60 Cal.2d 303, 305 (1963).

[2] Henderson v. Farmers Group, Inc. 210 Cal.App.4^Th 459 (2012)